Prediction of risk and diagnostic accuracy in patients hospitalized for decompensated heart failure: cohort study

Ernandes, Carolina Mirapalheta; Bernardes, Daniela de Souza; Mantovani, Vanessa Monteiro; Pedraza, Leticia Lopez; Rabelo-Silva, Eneida Rejane

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Revista Gaúcha de Enfermagem

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Original Article • Rev. Gaúcha Enferm. 40 • 2019 • https://doi.org/10.1590/1983-1447.2019.20180032 copy

Prediction of risk and diagnostic accuracy in patients hospitalized for decompensated heart failure: cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVES

To analyze the diagnostic accuracy in nursing in patients with predicted risk of clinical worsening during hospitalization for acutely decompensated heart failure.

METHODS

Cohort study with data collection in medical records according to the Acute Decompensated Heart Failure National Registry risk model. After defining the patients at risk, the Nursing Diagnosis Accuracy Scale version 2 was applied. The scale classifies the accuracy as null, low, moderate or high.

RESULTS

Of the 43 patients at risk of worsening, 22 (51%) did not worsen and 21 (49%) worsened; in both, the diagnostic accuracy was in the Moderate / High category in 22 (89%) and 16 (88%), respectively. Only Decreased cardiac output and Excessive fluid volume were scored with 100% in the High category.

CONCLUSIONS

Patients with acute decompensated heart failure and risk of clinical worsening during hospitalization were identified with moderate or high diagnostic accuracy by nurses.

KEYWORDS:
Nursing diagnosis; Data accuracy; Heart failure

Characteristics	n = 43
Age, years^*	70 ± 8
Sex, male	27 (63)
Race, white	37 (86)
Length of stay, days^†	9 (5-16)
In-hospital deaths	3 (7)
Etiology of HF, ischemic	16 (37)
Left ventricular ejection fraction (%)*	34 ± 14
Smoking	5 (12)
Coronary artery disease	15 (35)
Systemic arterial hypertension	31 (72)
Diabetes	22 (51)
Chronic kidney disease	14 (33)
Atrial fibrillation	18 (42)

Category of accuracy	Got worse	Did not get worse	*p-value
Low/Nil	3 (12)	2 (11)	NS
High/Moderate	22 (88)	16 (89)	NS

Nursing diagnosis	Got worse	Did not get worse
Decreased cardiac output	5 (71)	2 (29)
Fluid volume excess	2 (100)	0 (0)
Ineffective breathing pattern	13 (48)	14 (52)
Ineffective tissue perfusion: cardiopulmonary	5 (71)	2 (29)
Risk for ineffective respiratory function	1 (33)	2 (67)

Nursing diagnosis	n = 46

Ineffective breathing pattern	27 (63)
Decreased cardiac output	7 (16)
Ineffective tissue perfusion: cardiopulmonary	7 (16)
Risk for ineffective respiratory function	3 (7)
Fluid volume excess	2 (5)

Nursing diagnosis	Category of accuracy evaluator 1 n (%)	Category of accuracy evaluator 2 n (%)
Decreased cardiac output	High - 7 (100)	High - 7 (100)
Fluid volume excess	High - 2 (100)	High - 2 (100)
Ineffective breathing pattern	Nil - 1 (4) Low - 1 (4) Moderate - 4 (15) High - 21 (78)	Nil - 3 (11) Low - 2 (7) Moderate - 1 (4) High - 21 (78)
Ineffective tissue perfusion: cardiopulmonary	Nil - 2 (29) Low - 1 (14) High - 4 (57)	Nil - 2 (29) Low - 1 (14) High - 4 (57)
Risk for ineffective respiratory function	Nil - 3 (100)	Nil - 3 (100)

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
E-mail: revista@enf.ufrgs.br

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[1] Corresponding author:
Eneida Rejane Rabelo-Silva eneidarabelo@gmail.com